Training begins with the education of the private citizen. Courses in EMS system access, cardiopulmonary resuscitation (CPR), and other forms of first aid are essential. Communications media can be utilized to reach large populations with the minimum information necessary to educate citizens to respond to emergencies.
Some communities use a dual-response system consisting of first responders (FRs) followed by ambulance personnel. The FRs may be firefighters, police, park rangers, or citizen volunteers. The DOT National Highway Traffic Safety Administration (NHTSA) was initially given the responsibility of developing training curricula for EMS providers. The use of these curricula was tied to receipt of federal EMS grants, and the training programs were widely accepted and utilized nationally. Although their use is no longer required, DOT training standards are the de facto national standard for EMS education. Training for FRs may include the DOT FR course (which encompasses 60 h of classroom training) or similar courses developed by the American Red Cross or American Heart Association. The training for ambulance personnel usually requires completion of an emergency medical technician (EMT) course. Although various levels of EMT training have evolved in various states, there are three nationally recognized levels of EMTs: EMT basic (EMT-B), EMT intermediate (EMT-I), and EMT paramedic (EMT-P). The EMT-Bs have the necessary first aid skills to take care of immediately life-threatening prehospital emergency conditions. These skills include CPR, use of an automated external defibrillator (AED), and safe extrication, immobilization, and transportation of emergency victims. EMT-Bs are now being trained to assist patients in using their own nitroglycerin, epinephrine, and inhalers. There is an optional module in the DOT eMt-B curriculum on advanced airway techniques; it teaches EMT-Bs to perform endotracheal intubation or to use an advanced airway adjunct, such as a Combitube (Sheridan Corp, Argyle, NY). The decision to teach the optional airway module is generally made by the state EMS agency. EMT-I training includes the additional skills of intravenous access, pneumatic antishock garment use, and advanced airway techniques. EMT-P training adds drug therapy for selected prehospital conditions, interpretation of electrocardiogram (ECG) rhythms, synchronized cardioversion, and manual defibrillation. Clearly, physicians need to be deeply involved in EMT training to ensure that knowledge and skills are being taught appropriately and safely.
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